Paired Central and Peripheral Blood Cultures for Febrile Neutropenia in Pediatric Patients With Cancer: Do We Need...

Published clinical practice guidelines conditionally recommend using paired central and peripheral blood cultures for pediatric hematology/oncology (PHO) and hematopoietic stem-cell transplant (HSCT) patients to diagnose bloodstream infections (BSI) and central line-associated BSI (CLABSI). CLABSI can be diagnosed by differential time to positivity (DTP), where central venous line (CVL) blood cultures grow 120 minutes faster than peripheral cultures drawn at the same time. Peripheral cultures cause patient discomfort, risk contamination with skin flora, may cause delays in clinical care, and the overall impact is uncertain. We investigated our institution's paired blood culture practice to assess the utility and clinical impact of peripheral cultures.

All blood cultures for acute fever for PHO and HSCT patients were reviewed from January 1, 2020, through December 31, 2021. Blood culture sources, hospital location, BSI rates, and indications for CVL removal were analyzed.

Our PHO unit collected central-only cultures three times more frequently than paired cultures. A noncontaminant pathogen was isolated from peripheral cultures in seven of 625 paired culture events (1.1%). Twenty-five CVLs were removed, most often because of specific pathogen, septic shock, or persistent culture positivity despite appropriate antibiotics. DTP criteria suggested CLABSI in 15 patients, but CVL removal occurred in only seven cases; DTP was the sole criterion for removal only once.

Peripheral cultures had minimal overall impact toward BSI diagnosis and CVL removal in PHO patients. When a CVL is present, peripheral blood cultures were too infrequently useful to require as a standard of care.